Region set for more mental health services for critical age group

Lead therapist Andrea Delange, left, and program graduate Beth Wilkinson of Plainfield talk about mental health services for young adults on March 26 at the Quinebaug Day Treatment Center in Dayville. Such services for those ages 18 to 25 are about to increase locally.

Beth Wilkinson became her dying father's main caregiver at age 16, so she had to grow up fast.

"I was working, paying bills, going to school and taking care of my dad," said the Plainfield resident, who is now 23. "I ended up dropping out of high school four months before I was supposed to graduate."

Last year, Wilkinson earned her General Educational Development diploma, one of the positive steps she has taken to turn her life around after her father's death two years ago and a slide into drug addiction, an abusive relationship with a previous boyfriend and an arrest for driving her brother away from a bank he'd just robbed. But finding her way to the kind of counseling services that worked for her as a young adult, she said, wasn't easy.

"I tried other programs, and you're in groups of 30 or 40 mostly older people, and they look at you like, 'How much have you really gone through in life?'" Wilkinson said. "I felt like people were looking at me like a dumb kid."

Ultimately, Wilkinson found her way to a program at Natchaug Hospital especially for 18- to 25-year-olds, a group that experts say has unique mental health needs that aren't being addressed sufficiently by existing counseling services. Natchaug started the young adult program in Danielson in 2012, after launching a similar one at its main facility in Mansfield a year earlier. Five months ago, it created a third young adult program at its outpatient clinic in Groton. It has about three dozen patients in the three programs, with the intention of expanding as more patients seek care.

"We've been inundated with inquiries, and that's with little marketing," said Peter DeRosa, primary therapist at the Groton program, which is at capacity. "Young adults have unique needs, because they have the privileges and responsibilities of adults, but no experience dealing with them, and if supports aren't there, it can make it very difficult."

According to a state Department of Public Health study released in October, mental health crises including drug and alcohol abuse are the leading reasons for hospitalization for this age group. This is often the age, DeRosa said, when psychiatric problems first manifest and can be compounded by substance abuse. Symptoms often are triggered by some crisis such as job loss, arrest, changes in living arrangements or a relationship breakup, coupled with a lack of support or coping skills and no experience with accessing mental health care.

"The 18- to 25-year-old age range is usually when the onset of severe mental illnesses occur, when they start experiencing psychotic symptoms that were dormant in childhood," he said. "The brain doesn't fully develop until the mid 20s, and that's also a time when there are many new stresses in life."

Sound Community Services, which serves about 1,000 clients in New London County, also is responding to what administrators there see as an unmet need for mental health services specifically for young adults. The New London-based agency is opening an access center for this age group in the former Miracle Temple church on Bank Street in New London, offering them counseling, meals, classes, nursery care for young parents, access to computers and recording equipment, a place to socialize and other services. About $650,000 from the state Department of Mental Health and Addiction Services is supporting the new program. The building is being renovated for an opening sometime later this spring.

"This is for at-risk and homeless young adults," said Gino DeMaio, chief executive officer of Sound Community Services, adding that an outreach worker is meeting with 40 to 50 young men and women who are expected to be regulars at the new center once it opens. "We're pretty excited about this because we think this population is pretty underserved. We run the risk of potentially institutionalizing these people in the future if these issues aren't addressed."

About 70 to 100 Sound clients are in the 18- to-25 age range, he said, but there are an estimated 400 young adults throughout New London County who could benefit from the services the agency will provide at the new center.

State Mental Health Commissioner Patricia Rehmer said the new initiative at Sound Community Services for young adults reflects the overall increased focus by her agency on services for this age group in the aftermath of the Sandy Hook tragedy in 2012, when 20-year-old Adam Lanza killed 20 children and six staff members at a Newtown elementary school. About 10,000 young adults statewide receive services through programs funded by DMHAS, she said. Funding for young adults services has risen from $63.7 million in fiscal 2013, to $69.65 million this year, to a projected appropriation of $74.8 million in fiscal 2015.

"There is a belief that this is a population that's underserved and requires specialized services to engage them," said James Sieminowski, director of the Evaluation, Quality Management and Improvement Division of the state's mental health department.

Sound Community Services outreach workers have been trying to engage the young adults they encounter to interest them in coming to the new center, which will offer transportation services. These young men and women may have received mental health or special education services in high school, but stopped after graduating or dropping out, and often refused attempts to be transitioned into replacement programs or simply "fell through the cracks." They've "aged out" of the foster care system or other programs run by the state Department of Children and Families, and now want their independence.

"They think once they've turned 18, they're done. They're tired of people watching them," said Diane Tarricone, lead clinician for young adults services at Sound Community Services. "They do OK for a while, but then things fall apart."

They end up "couch-surfing" from friend to friend, sometimes at local homeless shelters. They are often jobless and try to "self medicate" with all kinds of illegal drugs and unusual substances, she said - from heroine and prescription drugs to snorting dried marigolds or nutmeg.

The key to reaching this group, she and DeMaio said, is to understand that cellphones and social media are often the most important things in their lives, sources of both connections with their peers as well as unrelenting stress for those who believe they never can disengage.

"Social media makes you very exposed, your dating life, your breakups," Tarricone said. "Sometimes arguments start on social media and then escalate and become physical."

They still have hope

Dana Dixon, program manager at the New London Homeless Hospitality Center, estimated that 25 percent of the 500 clients who stay at the shelter annually are young adults.

"They definitely need services, but they don't want structure," she said. "They don't want another class on how to write a resume. They want a job, an apartment, a girlfriend, but they don't have the skills to do that."

They are different from other shelter clients, she said, because "they still have a lot of hope. They think they're invincible." Substance abuse is also often involved.

Dixon welcomed the new program, which she hopes will help fill some of the gaps in services for this group. She noted that when shelter staff try to schedule an initial counseling appointment for a young client at a local agency, it can take two to three weeks.

"There's not enough inpatient beds or slots for one-on-one counseling," she said.

Rehmer, the state mental health commissioner, said his staff are trying to make contacts with teens receiving psychological services at school, or through DCF or private programs at age 16, so that by the time they're 18 they can transition into the state's adult programs without interruption.

"It's really critical to start at 16, because when they're older, they're often tired of being in the system," she said. "But engaging them is a challenge. Developmentally, they want to become more independent and less involved in the system. Sometimes they try to leave the system, and then they come back."

One of the new initiatives, she said, provides funds to train police officers and other emergency responders in handling mental health crises, with a particular focus on young adults. The department also received a federal grant to support youth mental health first-aid training, which teaches school administrators and others how to recognize a mental health crisis and how to respond. Thus far, about 100 people have received the training, and another group is slated to be trained this month, she said. The state legislature also has mandated additional school safety training programs, Siemianowski said.

"The Seven Challenges"

The mental health needs of young adults are better understood now than ever before, Rehmer said, thanks to research into how the brain develops in the late teens and 20s, and how it is affected by stress and trauma. Many young adults who need mental health treatment have experienced significant family trauma or abuse, she added.

"The research has caught up with the reality," she said.

Dr. Naomi Mendelovicz, interim chairwoman of the psychiatry department at Lawrence + Memorial Hospital in New London, said about one-quarter of the patients admitted to its Pond House inpatient psychiatric unit are 18 to 25 years old. Some of those with bipolar disorder or depression, who "had been in an environment with a huge amount of support" such as a residential school, are suddenly on their own trying to negotiate the adult mental health system. Or they decide suddenly to stop taking their medications, "because they don't want to feel like a person with an illness, and don't want to be controlled by medication." Young adults also often end up in the hospital's emergency room in some sort of mental health crisis, L+M psychiatric clinician Mia Graham-Burgess said

"Sometimes there's a gap in treatment, or it's due to addictions, or someone on the autism spectrum," said Graham-Burgess, who has a doctorate in medical anthropology. "Trying to place them is very difficult. They don't do well in large groups. We try to limit stimulation."

Mendelovicz said finding outpatient treatment for a young adult after hospitalization can be difficult. Often it can take two to three weeks to get an initial appointment, she said, and that can be too long for some patients to wait. Compounding the shortage is the fact that for anyone 18 or older, receiving mental health care is voluntary.

"The longer they wait, the less likely they are to enter into a care system," she said. "It's voluntary whether they want to participate. Ideally they need to be seen within a week of getting out of the hospital. There aren't enough providers in our community."

Beth Wilkinson says she is grateful she was one of the ones who found the right kind of treatment when she needed it. She said she decided to speak publicly about her experiences with the group and individual therapy she received in the Natchaug outpatient center so that others needing help will find their way there, too. The treatment for young adults offered both at Natchaug and at Sound Community Services is based on "The Seven Challenges" program created by Dr. Robert Schwebel, a step-by-step system developed for this age group.

"This program helped me so much," she said. "There were a lot of issues in my life I wouldn't have been able to handle on my own without it. I wanted everyone to know about this program."